Multiple sclerosis and COVID-19: A retrospective study in Iran

PLOS ONE RESEARCH ARTICLE Multiple sclerosis and COVID-19: A retrospective study in Iran Behnaz Sedighi1, Aliakbar Haghdoost2, Parya Jangipour Afshar3, Zohre Abna4, Shamimeh Bahmani5, Simin Jafari ID1,5* a1111111111 a1111111111 a1111111111 a1111111111 a1111111111 1 Neurology Research Center, Kerman University of Medical Sciences, Kerman, Iran, 2 Institute for Futures Studies in Health, Modeling in Health Research Center, Kerman University of Medical Sciences, Kerman, Iran, 3 Faculty of Public Health, Department of Biostatistics and Epidemiology, Kerman University of Medical Sciences, Kerman, Iran, 4 Tehran University of Medical Sciences, Tehran, Iran, 5 Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran * Abstract Objectives OPEN ACCESS Citation: Sedighi B, Haghdoost A, Jangipour Afshar P, Abna Z, Bahmani S, Jafari S (2023) Multiple sclerosis and COVID-19: A retrospective study in Iran. PLoS ONE 18(3): e0283538. https://doi.org/ 10.1371/journal.pone.0283538 Previous studies suggested a higher rate of COVID-19 infection in patients with multiple sclerosis than in the general population, and limited studies addressed the impact of COVID-19 and its vaccination in patients with multiple sclerosis in Iran. We decided to investigate the factors associated with COVID-19 infection, the effects and side effects of the COVID-19 vaccination in patients with multiple sclerosis (MS). Editor: Anza Bilal Memon, Henry Ford Health System, UNITED STATES Methods Received: August 14, 2022 Accepted: March 10, 2023 Published: March 23, 2023 Peer Review History: PLOS recognizes the benefits of transparency in the peer review process; therefore, we enable the publication of all of the content of peer review and author responses alongside final, published articles. The editorial history of this article is available here: https://doi.org/10.1371/journal.pone.0283538 Copyright: © 2023 Sedighi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: All relevant data are within the paper and its Supporting Information files. Funding: The author received no specific funding for this work. We used the data of the patients with multiple sclerosis registered in a referral clinic in Kerman, one of the large cities in Iran (a population of 537,000 inhabitants), to explore the association between demographic variables, the history of COVID-19 vaccination, and the clinical outcomes. Results Of the 367 participants in this study, 88.3% received the COVID-19 vaccine, 35.4% were confirmed COVID-19 cases, and the incidence of COVID-19 was much higher before vaccination (24.5% before vaccination versus 10.1% after vaccination). The multivariable logistic regression model showed that male gender (OR = 2.64, 95% confidence interval: 1.21, 5.74) and current employment (OR = 3.04, 95% confidence interval: 1.59, 5.80) were associated with an increased risk of COVID-19. The only factor associated with the adverse effects of COVID-19 vaccination was the type of vaccine (AstraZeneca). Conclusion Our findings showed that the vaccination protected MS cases considerably against COVID19. In addition, the side effects of the vaccines were not noticeably high in these cases as well. Among all COVID-19 vaccines, AstraZeneca had the most common side effects, so people must be aware of them before vaccination. The male gender and employment were PLOS ONE | https://doi.org/10.1371/journal.pone.0283538 March 23, 2023 1 / 11 PLOS ONE Competing interests: The authors have declared that no competing interests exist. Multiple sclerosis and covid-19 the most important variables in the prevalence of COVID-19 in patients with multiple sclerosis in our study. Introduction Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is responsible for COVID-19, which was first seen in Wuhan, China, in 2019 [1]. This disease is very contagious and manifests with fever, cough, myalgia, and dyspnea. The virus spread all over the world, resulting in a pandemic that killed 5.4 million people and infected more than 304 million people until January 9, 2022 [2]. COVID-19 posed a great challenge to all healthcare systems around the world, with the greatest impact on the health organizations of each country [3]. Multiple sclerosis (MS), one of the most disabling CNS diseases, is an autoimmune inflammatory demyelinating pathology that affects approximately 2.8 million people worldwide [4,5]. Many patients with multiple sclerosis have a suppressed immune system due to diseasemodifying therapy (DMT), so they are more at risk for infectious diseases than the general population [6]. The COVID-19 outbreak has caused many issues for patients with multiple sclerosis in various aspects of their lives, including fragile mental health, poor treatment follow-up, and increased annual hospitalization [7,8]. The suppressive immune system due to DMT has also raised concerns about the facilitation of COVID-19 infection in patients with MS [9–11]. Fortunately, initiating vaccination against COVID-19 has controlled the spread of the disease and improved the medical status of patients with MS [12,13]. Previous studies showed that COVID-19 has a higher rate of infection and hospitalization in patients with MS than in the general population, while early vaccination may be effective in reducing these rates [14]. Numerous studies were conducted on the patients with MS in Iran during the COVID-19 pandemic [7,8,15]. However, limited studies investigated the factors affecting COVID-19 infection, the effectiveness of vaccination, and the complications of vaccination in patients with MS in Iran. Most of these studies were conducted at the beginning of the pandemic [14,16–18]. The current study investigated the factors associated with COVID-19 infection, the impact of vaccination, as well as factors affecting the side effects of vaccination in patients with MS in Kerman Province, Iran. Materials and methods Study design and participants This retrospective study aimed to investigate the factors associated with the COVID-19 and the effectiveness and side effects of vaccination in patients with MS in a referral clinic in Kerman, one of the large cities in Iran, from March to December 2021. We used the data of patients registered in the referral hospital in Kerman province. Out of 548 registered cases, we recruited 367 (66.9%) and excluded those who disagreed or had a major non-communicable disease, such as diabetes, hypertension, cardiovascular, cerebrovascular, and respiratory diseases. The final diagnosis of MS in this registry was confirmed by neurologists who are affiliated with the Shafa hospital and the Kerman University of Medical Sciences, based on the revised McDonald criteria (2017) [19]. Outcomes measurement Dat (...truncated)